Use of autologous adipose tissue in acute burn wound management: A systematic review

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

Surgical rhinoplasty after prior hyaluronic acid based nose remodeling

BACKGROUND

Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients.

OBJECTIVES

The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans.

METHODS

We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections.

RESULTS

Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme.

CONCLUSION

Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

[Vulvoplasty after gender-affirmating genital surgery]

Functional and aesthetic results after vaginoplasty in sexual reassignment surgery have improved in recent years. Improved surgical techniques, well-established expert teams and a growing demand for and interest in this type of surgery are some of the reasons for these results. However, there is a growing demand for genital cosmetic surgery, not only among cis women, but also among trans women. The main shortcomings in results are therefore presented and listed. The aesthetic revision surgery techniques specifically indicated are described. Labiaplasty and clitoridoplasty appear to be the two main requests for secondary surgery following trans vaginoplasty.

[Not Available]

Platelet rich plasma (PRP) has trophic functions due to a high concentration of growth factors and cytokines. These properties may be of therapeutic interest in the management of burn injuries. In preparation for a clinical study at the Lyon Burn Centre on PRP as an inducer of healing in burns, we carried out a review of the literature looking at the results of the use of this therapy. A review of the literature on the use of PRP for the treatment of burn injuries was performed by querying the PUBMED database using the keywords [platelet rich plasma] AND [burns]. Controlled clinical or pre-clinical studies in English or French were included. Eleven articles were identified, consisting of eight preclinical animal model studies and three clinical studies. These looked at the effects of PRP on the healing of burned areas whether they were grafted or not, on the improvement of neuropathic pain, and on distant skin trophicity. The results of recent preclinical studies show shorter epithelialization times thanks to PRP. In humans, a significant study (201 patients) validates its use in combination with thin skin grafts, and another shows benefits on distant cutaneous trophicity. In conclusion, the use of PRP topically or by injection under the skin has a potential benefit in the management of acute burns. A large-scale series validates its use in clinical practice.

The bilateral scrotal flap: Anatomical study and it's use for the management of inflammatory granulomas following custom-made injections

INTRODUCTION

The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed.

METHODS

A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period.

RESULTS

We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis.

CONCLUSION

Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

Self-injection: Inescapable DIY and real danger? A case study and literature review

Aesthetic medicine is booming, and expanding Internet delivery is not controlled by health authorities. More than ever, conditions are thus favorable for patient self-injection. We present the case of a 45-year-old woman self-injected in breast with hyaluronic acid purchased on the Internet. She developed a bilateral breast infection treated with antibiotic treatment. Despite the ban on the use of filler in the breast by our health authorities since 2011, we will talk about the management of this type of patient. In light of this complication, we will discuss the public health issue raised by the development of the injectable products market. We wish to emphasize in France the emergency of establishing a strict legal framework for the use of fillers.

[Tissue expansion in child's burn reconstruction. Management principles and eleven years retrospective study of 42 patients]

PURPOSE

With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development.

MATERIAL AND METHODS

Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted.

RESULTS

There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face).

CONCLUSION

Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face.

Mandibular angle resection using cervicofacial lifting surgical approach: Technical note

Facial feminization surgery brings a set of surgical procedures that address the three thirds of the face and aims to give feminine characteristics to a masculine face. The characteristics of the lower third of a male face are a long, broad chin, a prominent mandible with sharp angles (in connection with the insertions of the masseter muscles). Mandibular angle reduction is an important procedure of the male-to-female transformation. It allows to modify the appearance of the lower third of the face, reducing the bi-mandibular distance in the coronal plane and opening the mandibular angle in profile. The classical procedure uses trans-oral surgical approach. However, patients undergoing male-to-female sexual transformation frequently present a mixed indication of cervicofacial lift and angular resection. We present an innovative surgical technique associating cervicofacial lifting and mandibular angle resection using the same cutaneous surgical approach. We describe its advantages and discuss its disadvantages.

[Profunda femoral artery perforator flap: Anatomical study]

BACKGROUND

Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options.

OBJECTIVE

This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP : position of the perforating artery; length of the pedicle, area and volume of vascularization.

METHODS

Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator.

RESULTS

On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2cm of the pubic tuber and 3.7cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7cm and the average area of skin perfused was 94,68cm². The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25cm² and a mean volume of 325.3cm³.

DISCUSSION

PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery.

An anatomic study of deep inferior epigastric artery diameters at the origin from external iliac and at the lateral border of rectus abdominis muscle by computed tomographic angiography from autologous breast reconstruction patients

BACKGROUND

Autologous breast reconstruction by means of microsurgical abdominal flaps is an very well described technique. The flap harvest dissection under inguinal ligament would cause the risk of parietal weakening in this zone and postoperative bulging. The goal of our study is to investigate whether the deep inferior epigastric artery diameter remains constant from its exit of the external iliac artery to its entrance in the rectus muscle sheath.

PATIENTS AND METHOD

One hundred arteries were studied on fifty preoperative computed tomographic angiographies made before a DIEAP flap for breast reconstruction. We measured the caliber of the left and right deep inferior epigastric arteries at these two landmarks. The length of this artery between these was also calculated. This data were collected with specific angiography reconstruction.

RESULTS

At the caudal landmark, the mean DIEA diameter was 2.1±0.27mm on the left side and 2.1±0.31mm on the right side. At the cephalic landmark, the mean DIEA diameter was 2.0±0.28mm on the left and 2.0±0.27mm on the right side (P=0.00035 at left side; P=0.0089 at right side). The mean pedicle length between the two landmarks was 22.3±2.85mm on the left side and 22.2±2.98mm on the right side.

CONCLUSION

This computed tomographic angiography study showed that the diameter of DIEA is equivalent at its origin and at the lateral border of muscle. Flap harvest without dissection under inguinal ligament provides sufficient pedicle length and caliber to allow for comfortable and reliable sutures.

Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization

BACKGROUND

Umbilical necrosis is a well-known complication of abdominoplasty, the risk of this complication can be increased when an associated umbilical hernia requires further dissection in peri-umbilical region, potentially leading to umbilical devascularisation. Multiple minimally invasive open techniques were described to avoid this problem. The combined approach of abdominoplasty with laparoscopic umbilical hernia repair is one promising solution to avoid devascularising the umbilicus.

METHODS

A retrospective evaluation of patients who underwent concomitant abdominoplasty with laparoscopic umbilical hernia repair from 2007 to 2017 was carried out. All patients were followed up and evaluated for complications, including the incidence of umbilical skin necrosis.

RESULTS

A total of 47 patients were included in this study. The average operative duration was 3.3hours with an average hospital stay of 2.5 days. No cases of postoperative umbilical necrosis were encountered. A mean follow-up period was 2.4 years showed no cases of hernia or rectus abdominis diastasis recurrence. Minor complications included 4 cases of dehiscence, one hematoma. There was no major complications.

CONCLUSION

The concomitant use of laparoscopic umbilical hernia repair and abdominoplasty is a feasible approach to reduce the risks of umbilical devascularization. Especially in larger hernias and in patients with higher risk of recurrence.

Reconstruction of soft tissue defects of the distal third of the arm using a muscle-sparing latissimus dorsi musculocutaneous flap

Use of a latissimus dorsi (LD) flap has been widely described for upper limb reconstruction. However, donor site sequelae have led to the development of muscle-sparing techniques for the LD flap. We present the technical principles of a muscle-sparing LD flap and its use as a pedicled flap to reconstruct the distal third of the arm.

Anatomy of lower eyelid and eyelid-cheek junction

BACKGROUND

Understanding the anatomy of the lower eyelid and the lid-cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment.

METHODS

A review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article.

RESULTS

The anatomy of the lower eyelid and the lid-cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization.

CONCLUSION

The understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures.

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers]

INTRODUCTION

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers.

PATIENTS AND METHOD

A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily.

RESULTS

A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory.

CONCLUSION

Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

Anatomy and Aesthetics of the Labia Minora: The Ideal Vulva?

Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nipple reconstruction using rib cartilage strut in microsurgical reconstructed breast

Nipple areolar reconstruction is the very last step of breast reconstruction. It is of outmost importance because it gives final appearance of breast, which is then better integreated by the patient in her body image. A lot of techniques are described to recreate nipple projection, from trompe l'œil tattoo to local flap, nipple sharing or autologous tissue graft. Common drawback of these techniques is nipple flattening with time, due to tissue atrophy. We present here a technique to use rib cartilage graft as structural framework for nipple reconstruction. Rib cartilage is stored in a pocked created in the groin during first step of breast microsurgical reconstruction. During nipple-areolar reconstruction, graft is cut at appropriate size and used inside a C-V flap to enhance nipple projection. Results show excellent symmetry and projection and is stable over time. Patients are very satisfied and can better integrate their new breast.

Pathways commonly dysregulated in mouse and human obese adipose tissue: FAT/CD36 modulates differentiation and lipogenesis

Obesity is linked to adipose tissue hypertrophy (increased adipocyte cell size) and hyperplasia (increased cell number). Comparative analyses of gene datasets allowed us to identify 1426 genes which may represent common adipose phenotype in humans and mice. Among them we identified several adipocyte-specific genes dysregulated in obese adipose tissue, involved in either fatty acid storage (acyl CoA synthase ACSL1, hormone-sensitive lipase LIPE, aquaporin 7 AQP7, perilipin PLIN) or cell adhesion (fibronectin FN1, collagens COL1A1, COL1A3, metalloprotein MMP9, or both (scavenger receptor FAT/CD36). Using real-time analysis of cell surface occupancy on xCELLigence system we developed a new method to study lipid uptake and differentiation of mouse 3T3L1 fibroblasts and human adipose stem cells. Both processes are regulated by insulin and fatty acids such as oleic acid. We showed that fatty acid addition to culture media increased the differentiation rate and was required for full differentiation into unilocular adipocytes. Significant activation of lipogenesis, i.e. lipid accumulation, by either insulin or oleic acid was monitored in times ranging from 1 to 24 h, depending on differentiation state, whereas significant effects on adipogenesis, i.e., surperimposed lipid accumulation and gene transcriptional regulations were measured after 3 to 4 d. Combination of selected times for analysis of lipid contents, cell counts, size fractionations, and gene transcriptional regulations showed that FAT/CD36 specific inhibitor AP5258 significantly increased cell survival of oleic acid-treated mouse and human adipocytes, and partially restored the transcriptional response to oleic acid in the presence of insulin through JNK pathway. Taken together, these data open new perspectives to study the molecular mechanisms commonly dysregulated in mouse and human obesity at the level of lipogenesis linked to hypertrophy and adipogenesis linked to hyperplasia.

[Optimization of primary aesthetic breast augmentation using implants: an evidence-based level approach]

The primary aesthetic breast augmentation has been the most performed cosmetic surgery procedure in the world for over 40 years. The current literature focuses on the new concept of "process of breast augmentation" and the importance of non-surgical part (patient selection, preoperative planning and personalized management of postoperative care) in potentiating the cosmetic results and reducing the rate of complications and reoperations. This review of literature discusses, through an analysis of scientific evidence levels, every step of the whole process of breast augmentation in order to determine the current best practices tailored to each patient to optimize satisfactory and durable cosmetic outcomes.

[Transtibial amputation salvage with a cutaneous flap based on posterior tibial perforators]

When performing an amputation of the lower limb, the preservation of the knee joint is important to obtain an optimal functional outcome. Many reconstruction procedures are available to cover the amputation defect in order to preserve a sufficient length of the stump, so a prosthesis could be put in place with the best functional results. Local musculocutaneous flaps or free flaps are conventionally described with their advantages and disadvantages. In this report, we describe our experience with a transtibial amputation and stump covering using a fasciocutaneous flap based on tibial posterior perforators. An extensive tibial bone exposure with only posterior skin was viable. It is an efficient and reliable solution for covering tibial stump without microvascular anastomosis.

[Diagnosis and treatment management of basal cell skin carcinoma - guidelines analysis]

Basal cell carcinoma (BCC) is the most frequent skin cancer in France. BCC has above all a local evolution with an important locoregional morbidity. BCC are found in 80% in the cervicofacial region. Surgery is currently recognized to be the most reliable treatment. The surgeon needs to achieve an in sano excision and must recover the defect with the less aesthetic consequences. The aim of this work is to combine and to get-at-able the recommandations of the "Haute Autorité de santé" of 2004, and also to supply some details for the clinical practice of the plastic surgeon.

[Retrospective study of third degree cervico-facial burns]

INTRODUCTION

Cervical and facial burns can be responsible of social and professional exclusions, functional limitations and psychological repercussions. Composite allotransplantation has become a reality for complex facial reconstructions. The purpose of this study is to evaluate the sequelae of third degree facial burns that might fit into a facial transplant program.

PATIENTS AND METHODS

We conducted a retrospective study in our burn unit from May 2006 to July 2009. We included all the patients with third degree cervico-facial burns. One hundred and eighty seven patients were selected. We excluded 87 patients for insufficient initial photography or lack in the medical data. The topography of the facial burns was analysed for each patient and separated into different aesthetic sub units. A questionnaire was mailed to the patients evaluating the psychological, functional and aesthetic sequelae.

RESULTS

The follow-up was of 12 months at least. Of the 100 patients, 82 presented with partial facial burns and 18 with full facial burns. Of the 82 patients with partial burns, 48% had burns in the chin area, 45% in the neck area, 41% in the cheeks and 37% in the ears. The sub units associated with functional sequelae were the neck (32%) and the peri-buccal and peri-orbital region (11-14%). On the 100 questionnaires, 28 patients responded.

CONCLUSION

Third degree burns sequelae concerned mainly the neck and the lower third of the face. The indication of facial allotransplantation remains rare in the burn patient. The deep carbonisation and the very extensive burn patient with severe functional sequelae where the standard reconstructive procedures are inefficient might be eligible for a facial allotransplant program.

A simple way to reconstruct a human 3-d hypodermis: a useful tool for pharmacological functionality

BACKGROUND

Adipose tissue engineering has been hampered by the inability to culture mature adipocytes. Adipose-derived stem cell (ASC) culture opens the way for the preparation of human 3-D hypodermis in large quantities. These models play a role in obesity-related active molecules and slimming agent screening. Moreover, they contribute to a better understanding of the mechanisms underpinning obesity.

MATERIALS AND METHODS

Freshly extracted ASC from fat tissue were characterized by flow cytometry for CD73, CD90, CD105, HLA-ABC, CD14 and CD45 markers and by Western blot for pref-1. Their differentiation in mature adipocytes was followed by lipid and adiponectin secretion or by oil red O staining and radioimmunoassay. Neosynthesized extracellular matrix (ECM) of 3-D hypodermis was investigated by immunohistochemistry (collagen type I, V and VI) and transmission electron microscopy.

RESULTS

Our results demonstrate that the culture of preadipocytes in proliferation medium for 15 days followed by 16 days of culture in differentiation medium allowed production of the thickest single-layer hypodermis in which preadipocytes and mature adipocytes coexist and synthesize adiponectin and ECM components. Functionality of our 3-D single-layer hypodermis was demonstrated both by a 3.5-fold glycerol production after its stimulation with norepinephrine (adrenergic agonist) and by its slimming after caffeine treatment versus the nontreated 3-D hypodermis.

CONCLUSION

This economic 3-D model, easy to prepare and giving reproducible results after the treatment of actives, is useful for pharmacotoxicological trials as an alternative to animal experimentation.

[The adipose tissue transfer in the mammary parenchyma (part I): Review of the literature on modifications of the radiological images]

The adipose tissue transfer (ATT) in the mammary parenchyma is a subject of controversy and generates passionate debates in scientific meetings. So far, many phenomena remain unexplained. Among these phenomena, changes in mammogram images generated by the grafted adipose tissue and the interactions between the grafted adipose tissue and a clinically undetectable breast cancer are the most important. We will present a series of articles with a critical analysis of the scientific literature on each of these phenomena. This first article presents the review of the literature on modifications of the radiological images after ATT. Two types of images are most common in mammograms after ATT. These are oil cysts and microcalcifications. Regarding to the presented review of literature, there is not yet sufficient evidence to prove a similarity or not between these images generated by the ATT and those from a breast malignancy. Therefore, clinically, patients must be included in a prospective clinical trial and in terms of research, the first step should be an exhaustive description of radiological images after ATT and a comparison of these images to images of malignancy. So, it's important to include these patients in prospective protocols with close and long term follow-up.

Optimization of a culture medium for the differentiation of preadipocytes into adipocytes in a monolayer

Our objective was to optimize a medium for preadipocyte differentiation into adipocytes.

METHODS

The differentiation medium contains fixed components as well as 7 variable ones. To perform this study, different experiments were designed and the study was carried out in 4 stages. The first two stages tested the influence of serum, dexamethasone, hydrocortisone and an cAMP activator. In the third stage, two new variables were added: rosiglitazone and insulin. In the final stage, the medium selected in stage 3 was validated. The differentiation selection criteria consisted of the number of mature adipocytes and adiponectin secretion.

RESULTS

We have shown that each variable was indispensable and that positive interactions occurred between some variables. No negative interactions were found and it was possible to optimize the concentration of each variable.

CONCLUSIONS

We selected the following medium, which provides optimal adipocyte size and adiponectin secretion: DMEM/HAMF12+10% Foetal Clone Serum (FCS)+2 nM triiodothyronine+10 nM hydrocortisone +0.5 mM IsoButyl Methyl Xanthine (IBMX)+500 nM dexamethasone+1 microM rosiglitazone+0.15 UI/ml insulin+antibiotics.

Adipose Tissue Increase Dramatically the Tumour Growth When Co-Injected with Breast Cancer Cell Lines: A Prudence Recommendation for Autologous Fat Transfer in Breast

Background: Autologous fat transfer takes an increasingly importance in plastic surgery. Indeed during the last decade, fat transfer was first of all used for breast reconstruction and now in breast augmentation, breast asymmetry, breast defects after lumpectomy and in some other breast deformation. Nevertheless this extension of the technique in the mammary parenchyma raises several questions. One of the most crucial interrogation is related to the type of interaction induced by the adipose tissue grafted with the breast cancer cells, interaction which remains poorly understood. Data from the literature evoked that these interactions lead to induce the increase of tumour growth properties. To decipher this interrogation, we designed experiments whose aims are to better understand and evaluate the actions and interactions induced by the xenograft of adipose tissue plus breast cancer cells in terms of tumour growth properties.Method: To study the impact of fat in tumours growth properties, we performed experiments of co-implantation of a panel of breast cancer cell lines (two humans: MDAMB-231 and SUM-159 PT ; and one mice: 67NR) with human adipose tissue from abdominal liposuction in nude mice. It was reported that tumour progression is the product of an evolving cross talk between tumour cells and its surrounding supportive tissue, the tumour stroma. Since mature adipocytes are radioresistant compared to other components of the tumour stroma, we investigated the effect of irradiated (15 Gray) or not adipose tissue on tumour growth properties. In each experiment we used 3 groups. The first one xenografted with cell lines only, the second one xenografted with cell plus fat and in the last constituted of cell plus irradiated fat. At the end of experiments mice were sacrificed and tumours were removed, dissected and one part was fixed and the other one (piece 2mm3) was re-implanted in a new mice. In these new groups we also studied the tumours growth and tumours tissue as previously described to evaluate the “possible” long time effect.Results-discussion: We have showed, whatever the cell line, that co-implantation of human fat (irradiated or not) with breast cancer cell lines induces a dramatic increase in tumour growth properties compared to cell line alone. Furthermore, the preliminary in vitro results associated to the ongoing immunohistochemistry analysis performed in the tumours from in vivo experiments of co-injection of fat plus breast cancer cell lines, gives related-results in term of tumour growth properties such as those observed in the in vivo experiment. Even-if larger in vitro studies are needed and are ongoing to consolidate our in vivo results, the whole of these results lead us to emit a recommendation of prudence with respect to this technique in mammary parenchyma.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3102.

[Contributions and results of lipo-structure in repair and rejuvenation of frontal anatomical unit]

Forehead is the most large anatomical unit of face. It includes forehead and anterior part of temple. Deteriorations of frontal anatomical units are numerous, ageing forehead has atrophy with eyebrow ptosis. In this work, we want to estimate contribution of lipo-structure in repair and rejuvenation of frontal anatomical unit (FAU). We present seven cases of repair of FAU and three cases of rejuvenation of the forehead. Results are satisfactory, particularly about frontal band. Results are questionable about Lipo-structure of temple. Applications of Lipo-structure in plastic and aesthetic surgery of the forehead are huge. Lipo-structure is the reference technique of volumetric filling. It is preferred to other techniques as flaps (pediculed or free) or materials, because it is a safe, easy and efficient technique, which permits large fillings. In aesthetic surgery, Lipo-structure gives volume to eyebrow region and fills root of the nose. It can be used with injections of botulinum toxin A. Lipo-structure of forehead takes part in rejuvenation of eye and nose. In conclusion, lipo-structure is actually the major technique of filling with a large implication in plastic and aesthetic surgery of FAU.

Influence of negative pressure when harvesting adipose tissue on cell yield of the stromal-vascular fraction

Adipose tissue is the standard autologous filling material used in plastic surgery today. At the same time it is also a source of mesenchymal stem cells, situated in the Stromal-Vascular Fraction (SVF) and easy to obtain in large quantities. The method of harvesting adipose tissue is an important stage for cell survival. So far, comparative studies on harvesting techniques have only concerned MTT cell viability of mature adipocytes. The aim of our study was to determine the influence of pressure on the yield of SVF cells in relation to the syringe aspiration technique which is the standard technique in plastic surgery. For this, six different harvesting conditions were tested on 3 patients. For each condition, a sample was taken from the trochanter region with the help of a 3 mm cannula, manual aspiration by a 10 ml syringe; wall suction; the traditional pump suction at -350 and -700 mmHg; the power assisted liposuction at -350 and -700 mmHg. Cell yield with a pressure of -350 mmHg, assisted or not, was greater than that obtained at -700 mmHg and significantly superior to aspiration with a syringe (p<0.05). At -350 mmHg, the use of power-assisted liposuction gave better results for two out of three patients when compared to non-power-assisted liposuction. Negative pressure is a factor influencing the number of SVF cells harvested.

Does adipose tissue cultured with collagen matrix and preadipocytes give comparable results to the standard technique in plastic surgery?

INTRODUCTION

Repairing contour defects is a challenge in plastic surgery. Different filling materials have been used with inadequate results and complications. The autologous fat transfer is the standard technique at the moment, but adipose tissue reserves are limited. The aim of our study was to compare in vivo on an animal model, preadipocytes cultured in a collagen scaffold versus adipose tissue transferred by the usual surgical technique.

MATERIALS AND METHODS

In order to compare adipocytes resulting from the differentiation of preadipocytes with those of purified adipose tissue, we implanted them in 10 nude mice. The preadipocytes were implanted using a collagen scaffold as intermediary and the adipose tissue following the plastic surgery protocol described by SR Coleman. After 8 weeks, tissue fragments were explanted and analysed after staining with HPS, Oil Red O and labelling with human anti-vimentin antibodies.

RESULTS

The scaffold seeded with preadipocytes had the macroscopic appearance of adipose tissue with peripheral neovascularisation. The preadipocytes had been transformed into mature adipocytes. Purified adipose tissue also presented peripheral neovascularisation. Numerous mature adipocytes were found. There was an abundant murine extracellular matrix since anti-vimentin labelling was negative.

CONCLUSION

This experimental study showed that adipose tissue engineering is feasible and gives comparable results to fat grafting. It allows a better understanding of the sequence of events following the transfer of adipose tissue. It provides not only volume but also undeniable stimulation, leading to significant thickening of the extracellular matrix.